title: Outcomes of buttonhole and rope-ladder cannulation techniques in a tropical renal service.
abstract: BACKGROUND
  Buttonhole cannulation was introduced into this Queensland Renal Service in 2005. Contrary to published literature, a local review of cannulation outcomes found no greater likelihood of infections with the buttonhole technique.
  
  
  OBJECTIVE
  To compare the outcomes of buttonhole and rope-ladder cannulation techniques.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Consenting patients attending for haemodialysis via an existing arteriovenous fistula (n = 104).
  
  
  METHODS
  Cannulation sites were assessed at every dialysis session for 12 weeks; fear and pain were scored by participants weekly.
  
  
  RESULTS
  No statistically significant differences in infection, haematoma formation, pain or fear between the techniques. Occurrence of aneurysm was higher (p < 0.05) in the rope-ladder group. More patients in buttonhole group required multiple cannulation attempts (p < 0.05). More of the rope-ladder group failed to attend their scheduled dialysis sessions (p < 0.05).
  This study confirms that in this setting there are few negative outcomes of either technique of fistula cannulation. Specifically, buttonhole cannulation appears to be a safe alternative means of fistula access to the gold-standard cannulation technique. The Service is examining strategies to improve attendance.
authors.affiliation: Tropical Health Research Unit for Nursing and Midwifery Practice, Townsville Hospital and Health Service, Townsville, Queensland, Australia. wendy_smyth@health.qld.gov.au
authors.forename: Wendy
authors.initials: W
authors.lastname: Smyth
authors.forename: Vicki
authors.initials: V
authors.lastname: Hartig
authors.forename: Valli
authors.initials: V
authors.lastname: Manickam
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000453:epidemiology / Q000451:nursing; D001164:Arteriovenous Fistula / Q000451:nursing*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000451:nursing; D002404:Catheterization / Q000379:methods* / Q000451:nursing*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006406:Hematoma / Q000453:epidemiology / Q000451:nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement / Q000451:nursing; D057240:Patient Preference; D011446:Prospective Studies; D011793:Queensland; D006435:Renal Dialysis / Q000451:nursing*; D062666:Vascular Access Devices
keywords: Buttonhole; Haemodialysis; Nursing; Research; Vascular access